- The Washington Times
Wednesday, November 9, 2022

South Dakotans voted on Election Day to expand Medicaid coverage, overcoming formal Republican opposition to a key plank of Obamacare.

The ballot measure succeeded with about 56% support and 44% opposed with most of the votes counted early Wednesday. Under the expansion, about 40,000 South Dakota low-income residents will become eligible for the federal-state insurance program.


South Dakota follows six states — Idaho, Maine, Missouri, Nebraska, Oklahoma and Utah — that used the ballot to expand Medicaid after Republican governors or lawmakers said the state share of the expansion costs would be untenable.

Grassroot supporters said states were leaving a good deal on the table because the Affordable Care Act requires the federal government to pick up 90% of the cost of expansion and President Biden sweetened the deal with an extra 5%.

“We are thrilled by this victory, which took years of work, coalition building and organizing to achieve,” said Kelly Hall, director of the Fairness Project, which spearheaded the effort. “Citizens took matters into their own hands to pass Medicaid expansion via ballot measure — showing us once again that if politicians won’t do their job, their constituents will step up and do it for them.”

Medicaid expansion is a major part of the 2010 healthcare law alongside insurance exchanges where people can shop for private insurance with the help of federal subsidies.


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Obamacare called on states to expand coverage to those making up to 133% percent of the federal poverty level, but the Supreme Court made expansion optional in its landmark 2012 decision upholding the overall program.

Today, all but 11 states have expanded coverage. Texas and Florida are major holdouts.

South Dakota Gov. Kristi Noem, a Republican, and state GOP lawmakers opposed expansion, saying it would cost taxpayers too much and discourage able-bodied people from working. The governor said she wouldn’t stand in the way if voters opted for expansion.

“If it passes I’ll make sure it’s implemented fairly,” she told CNN in July.

• Tom Howell Jr. can be reached at thowell@washingtontimes.com.


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